TMJ: kinematics and treatment of the dysfunction thru manual therapy and segmental stabilization of the cervical spine

Abstract

The role of physiotherapy has been increasingly important in the treatment of temporomandibular disorders (TMDs). In the physiotherapist clinical setting, for practical reasons, the motion analysis is often based on observation. However, in order to systematically quantify different kinematic aspects, it was necessary to create more objective methods that would provide a three dimensional reconstruction of movement in a global coordinate system. However, fixing markers on the skin can cause measurement errors because they are influenced by the skin stretching and its position depends on palpation of anatomical structures that can vary depending on the evaluator skill and anthropometric characteristics of the subject. Bearing in mind that there is no study testing the reliability of anatomical points on the face, the aims of Study 1 are: (1) analyze test-retest reliability intra and inter-session, minimum detectable difference and standard error of measurement of 3D kinematic variables during mouth opening and closing movements and (2) determine the inter and intra rater reliability of placing markers on the face, head and trunk through palpation in healthy subjects and to evaluate the influence of discrepancies in the variability of 3D kinematic motion of mouth opening and closing. Furthermore, Considering that the literature shows an important functional, static and dynamic relationship between the upper cervical spine and temporomandibular joint, but there is little evidence showing that TMD treatment through the cervical spine can be effective, Study 2 will use kinematics and clinical variables to evaluate the effect of 10 sessions of a craniocervical mobilization and stabilization protocol in subjects with TMD compared to control group. Moreover, some variables will be quantified during the 10 sessions protocol, enabling as a secondary objective, verify how many sessions are necessary for the therapy to be effective.